Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Journal of the Academy of Hospital Administration

Modernisation: Medical Technology and Changing Clinical Practice Patterns, Can we Afford it?

Author(s): S.M. Garg*, A. Chakravarty**

Vol. 13, No. 2 (2001-07 - 2001-12)

Key Message:

A planned modernisation initiative adoption of improved technology may be ineffective or even

Rational use of Health Technology will optimise hospital resources and it will be cost effective.


Ever increasing demands for high technology diagnostic and therapeutic health care facilities and their availability has come into conflict with medical necessity, social justice and cost effectiveness. Various issues related with changing practice pattern of clinicians consequent to adoption of high medical technologies under Modernisation plan are discussed. This paper also addresses the issue of unplanned Modernisation and its affordability in future. The suggested guidelines can be used as starting point while formulating medical decision rules on "Rational Use of Health Technologies" for optimizing the hospital resources.

Keywords : Modernisation, Medical Technology, Affordability, Rationalisation


Rapidly changing medical technology and availability of high technology diagnostic and therapeutic equipment with changing practice pattern of doctors has revolutionarised the way health care is being delivered today 1. Most of the Health Care Institutes are Modernising their Healthcare facilities to keep pace with technology available globally. While cost is major global concern before adopting Modern Technology in most of the developed countries, paradoxically the scarce regard is paid by developing countries to the cost factor and more so in government funded Hospitals/health care institutes2.

Research on the clinical, economical, and social implications of new and emerging health care technologies is limited. The clinicians consider it their moral duty to provide what will benefit the patients according to his or her ability and judgment, even when the patients or their surrogates did not believe it was of any use3. The availability of high technology and consumer awareness has made clinicians repeatedly use scarce resources, for people who do not need them, significantly violating their autonomy by influencing their clinical decisions.


This change in clinical practice pattern and resultant squandering of limited hospital resources is cause of concern for hospital administrators. Hospital administrators in their anxiety to impose efficiency, cost effectiveness and rationality in use of Modern Technology have paved the way for moral underpinning between clinicians and administrators.

The emerging issues related to Modernisation are:

  • Who will ascertain needs for and the suitability of health technologies in health services to improve the quality and cost-effectiveness of health care?
  • How decisions are being made in the acquisition of latest medical technologies? Whose perspectives and interest are being served?
  • Is there any system of post acquisition Health Technology Assessment (HTA)? Do we have capability to absorb and productively utilize foreign technology?
  • Is there any system of controlling high technology services being provided? Who decides medical necessity?
  • Is rationing of high technology health services possible?
  • Technology accounts for 50% increase in cost of medical care. Can we afford it without rationing?

Needs Assessment

An integrated health care facility planning and budgeting system to assess/validate health care facility and equipment requirements at command level is needed.

Information needed by the planner (e.g., mission, staffing and workload expectations each facility wise) to asses the need should be available. EPS (Equipment planning system) is a comprehensive tool for planning all the aspects of medical and non-medical equipment for a medical facility2.

Process of Acquiring Medical Technology

In a survey of approximately 200 hospitals (both public and private) and 800 policy makers e.g. hospital directors, heads of departments of teaching and research Institutes in Mexico, the results concluded that 60% of hospitals surveyed in Mexico had no formal process for acquiring technologies while the remaining 40% had an informal process fro medical technology acquisition4. Process should have well laid out strategy, policy, guidelines, human resource development plan, space planning system (SPS) and Equipment planning system (EPS).

Health Technology Assessment (HTA)

WHO Collaborating Center for Health Technology Assessment in its biannual report recommended, collecting, appraising and disseminating information on important local and global health technology issues and making this available to government, training institutions and other interested parties52. Promoting the development and utilization of health technologies that can have a major impact in reducing morbidity and mortality at the community level and in under served areas should be the goal of any HTA initiatives.

Controlling High Technology Services

Issues are related to clinicians/administrators power to withhold, withdraw or fail to recommend a technology/service that in the best clinical/administrative judgment, is neither in the best interest of society at large nor to patient due to high cost outweighs marginal benefits6. High tech intervention, In-vitro fertilisation, gene therapy, private rooms, cosmetic surgery, face lifts and high cost medication with no proven clinical efficacy are definitely out of "Must have" health technology.

Medical necessity and rationing of high technology health services

In a world of invariably scarce resources giving one Hospital everything that is expected to under modernisation will come at the expense of others. Traditionally clinician's decision to provide high tech diagnostic or therapeutic services is deterministic (Yes or No control). Such thresholds can be misleading as perception of patients, providers, insurers, society, courts have different values and objectives while determining medical necessity 7.

The clinicians can influence the patient's health decisions and even the way patients express their values because of inherent power discrepancy in Doctor - Patient relationship. Clinicians practice pattern is also affected by the extent of available medical technology/services. It is correct to rationing decision bases on principles of equity, standardization, medical necessity, and cost effectiveness.


There is a need to plan modernisation initiatives and review available medical technology based on objective assessment and empirical data, which needs to be compiled and scientifically analysed. Scarcity of monitory resources can only be combated with better planning and application of modern management tools.

Lack of awareness of management methods and technique is the cause of unplanned Modernisation and acquisition of high cost technology with marginal benefits, which if continued may soon become non affordableL2. Balancing medical outcomes, relative cost, societal values and patients risk and preferences is a cost effective exercise requiring special expertise not generally found among doctors. WHO Collaborating Center for Health Technology Assessment assistance can be taken for formulating medical decision guidelines on "Rational Use of Health Technologies" and appropriate technology acquisition. A planned modernization initiative will prevent adoption of unproven technology that may be ineffective or even harmful.


  1. Medical Technology and Practice Patterns Institute Annual Bulletin. 1996, 1997 available on e-mail, [email protected]
  2. Perry, S. Health Technology Assessment: Developing and Developed Countries, published in: Health in the Commonwealth: Challenges and Solutions 1998/99, London, England. Kensington Publications ltd. 1998, pp. 68-70.
  3. Veatch RM. The role of ethics in quality and accountability initiatives. Medical care 1995; 330; JS 69-76
  4. Perry, S., Gardner, E., Thamer, M.: The Status of Health Technology Assessment Worldwide: Results of an International Survey. Int. J. Technology Assessment in Health Care 13 : 1997: 81-98.
  5. WHO Collaborating Center for Health Technology Assessment. Biannual Report. 1998-99, January 4, 2000.
  6. Peter a Ubel, Goolds S. Recognising bedside rationing: clear cases and tough calls Ann Inern Med. 1997:126; 74-80.
  7. Marimer WK. patients rights after health care reform: Who decides what is medically necessary? Am J public Health. 1994:84; 1515-20.

* RPO, DG 2Group
** Addl. DGAFMS(EandS), o/o DGAFMS, M Block, New Delhi-1

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica